Background to this inspection
Updated
21 September 2022
Inspection team
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
St Bridget’s Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and we looked at both during this inspection.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
Inspection activity started on 7 July 2022 and ended on 27 July 2022. We visited St Bridget’s Residential Home on 7, 8 and 21 July 2022. We spoke with six people who used the service and four relatives about their experience of the care provided. We spoke with nine members of staff including the provider, registered manager, senior care workers, care workers and the chef. We observed care to help us understand the experience of people who could not talk with us. We reviewed a range of records. This included six people's care records and multiple medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
21 September 2022
About the service
St Bridget’s Residential Home is a residential care home providing personal care for up to ten people aged 65 and over. At the time of our inspection there were nine people using the service. Accommodation is provided over two floors of a converted house situated in a residential street.
People’s experience of using this service and what we found
People told us they felt safe and were happy. Relatives told us the staff were kind and caring. However, we found shortfalls that had placed people at risk of harm.
The service had not made many improvements since our last inspection where we found breaches of the regulations in relation to reporting incidents and risk to statutory agencies, making notifications to the care quality commission, record keeping of peoples’ care needs and governance. This had led to us finding ineffective systems and processes that had placed people at risk of harm.
The service had not appropriately identified risks to peoples’ health and safety and medicines were not managed safely. There were not sufficient staff to ensure peoples’ needs were met in the afternoons.
People had not had their needs robustly assessed before they were admitted into the building to ensure the service could meet their care needs. The adaptation and design of the building did not support people with disabilities and reasonable adjustments had not been made to ensure people could enter and exit easily.
People were not supported to have maximum choice and control of their lives; people were not supported in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Care plans were not person centred and staff had not been provided with enough information to meet people’s individual care needs. This was identified at our previous inspection and no improvements had been made.
People had not been supported to take part in activities whether in a group or one to one that were socially or culturally relevant to them. This had been identified at our previous inspection and no improvements had been made.
There were no robust governance systems and processes in place to monitor and assess the quality of the service. This had led to shortfalls found in the inspection that had placed people at risk of harm. A lack of governance and oversight had been identified at our last inspection however no improvements had been made at the service.
People and relatives spoke positively about the staff and told us they were “kind and caring.” People said if they asked for something, for example a cup of tea, they didn’t have to ask twice.
Staff knew how to report signs of abuse and the registered manager had made appropriate safeguarding referrals; this had improved since our last inspection. We received positive feedback from one healthcare professional who told us staff listened to their instructions. People enjoyed the food.
People and relatives told us they found the registered manager approachable.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 18 August 2021).
At our last inspection we found breaches of the regulations in relation to reporting incidents and risk to statutory agencies, making notifications to the care quality commission, record keeping of people's care needs and governance. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve. At this inspection, we found the provider remained in breach of regulations.
Why we inspected
We were prompted to carry out this inspection due to concerns we received about record keeping of people's care needs, medicine management, social engagement and governance. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have found breaches in relation to keeping records to provide consistent and safe person-centred care, identifying and managing risks, providing support to people in a restrictive way, governance and having sufficient staff to meet people’s care needs.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is inadequate and the service is therefore in special measures. This means we will keep the service under review and will re-inspect within six months of the date we published this report to check for significant improvements.
If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means that if we have not already done so, we will start processes that will prevent the provider from continuing to operate the service.
For adult social care services, the maximum time for being in special measures will usually be 12 months. If the service has shown improvements when we inspect it, and it is no longer rated inadequate for any of the five key questions, it will no longer be in special measures.